From the Guidelines
Estrogen therapy is a beneficial treatment option for desquamative inflammatory vaginitis (DIV), as it helps restore vaginal tissue health and reduce inflammation. According to the most recent guidelines, vaginal estrogen is the most effective treatment for vaginal dryness leading to sexual dysfunction and has been shown to be effective in treating itching, discomfort, and painful intercourse in postmenopausal individuals 1. The use of topical estrogen preparations, such as estradiol vaginal cream, can help improve vaginal epithelial maturation, increase glycogen production, and restore normal vaginal pH and microbiome, which helps reduce inflammation and symptoms like discharge, burning, and pain.
Some key points to consider when using estrogen therapy for DIV include:
- The treatment duration may vary, but often continues for several months, with gradual tapering to find the minimum effective maintenance dose 1.
- Some patients may require long-term therapy to prevent recurrence.
- Women with contraindications to estrogen therapy, such as certain types of breast cancer, should discuss alternative options with their healthcare provider, as the safety of vaginal hormones has not been firmly established in survivors of estrogen-dependent cancers 1.
- Estrogen therapy is typically used alongside other treatments, such as antibiotics like clindamycin cream or hydrocortisone, as the condition involves both inflammation and altered vaginal flora.
It's essential to note that while estrogen therapy is beneficial, its use should be carefully considered in patients with a history of estrogen-dependent cancers, and alternative options like ospemifene, a selective estrogen receptor modulator (SERM), may be recommended 1. Overall, estrogen therapy can be an effective treatment option for DIV, but it's crucial to weigh the benefits and risks and consider individual patient factors.
From the Research
Estrogen Treatment for Desquamative Inflammatory Vaginitis
- Estrogen can be used to treat desquamative inflammatory vaginitis, particularly in cases with a severe atrophy component 2.
- The use of local estrogens can help alleviate symptoms of desquamative inflammatory vaginitis, especially in postmenopausal women or those with a contraindication for estrogens 2.
- However, other studies suggest that desquamative inflammatory vaginitis is a chronic inflammatory process that responds well to topical anti-inflammatory therapy, such as clindamycin or hydrocortisone, rather than estrogen treatment 3, 4.
- The effectiveness of estrogen treatment for desquamative inflammatory vaginitis is not extensively discussed in the available studies, and more research is needed to determine its efficacy 5, 6.
Alternative Treatments for Desquamative Inflammatory Vaginitis
- Topical clindamycin and hydrocortisone are commonly used to treat desquamative inflammatory vaginitis, with significant symptom relief observed in many patients 3, 4.
- Steroid therapy, either local or systemic, has also been used to treat desquamative inflammatory vaginitis, although the response to treatment can vary 6.
- The use of probiotics with an ultra-low dose of local estriol may be considered in some cases, particularly in postmenopausal or breast cancer patients with a contraindication for estrogens 2.